Operation theatre services

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Operation Thea

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  • 1. Hospital Administration Made Easy
    PLANNING AND ORGANIZATIONOF OPERATION DEPARTMENT
    DR.N.C.DAS
  • 2. PLANNING AND ORGANIZATION OFOPERATION DEPARTMENT
    With recent technological development in medical science and increase public demand the modern surgical practices is becoming more complex and expensive affairs.
    About 50% of all hospital beds are allocated to surgical departments.
    Surgical facilities, therefore represents a central life saving activity.
    Therefore its success or failure highly influence the hospital reputation.
    (v) This has led to a detailed scientific planning of the operation theater complex.
  • 3. 1. To promote highest standard of asepsis.
    To ensure maximum safety for patients and staff from installation hazards.
    Optimum utilization of OT and staff time.
    Smooth and effective functioning of OT.
    Good working environment for doctors and staff.
    Allow flexibility by use of multiple operation suits.
    OBJECTIVE OF PLANNING
  • 4. PLANNING CRITERIA
    To meet the objectives and functions of the OTs, the planning consideration
    must meet the following criteria's.
    ERGOMETRIC
    OR
    WORK FLOW
    FUNCTIONS
    Location
    Size
    No of OTs
    Grouping of OTs
    Zoning
    Equipment
    Installation
    Space for free movement of
    Staff, patients, supplies
    PLANNING
    CRITERIA
    ENVIRONMENTAL
    TECHNICAL
    Lighting
    Air Conditioning
    Ventilation
    Water Supply
    Fire Safety
    Plumbing
    Clothing
    OT Staff
    Functional Areas
    Preparation of patient
    Sterilization Units
    Scrub Station
    Designing & Finishing
  • 5. FUNCTIONAL CONSIDERATION
    LOCATION:
    Maximum six suits in one OT complex, preferably ground floor.
    Easy access to CSSD, sterilization unit, emergency and surgical wards.
    Maximum protection from sun, sounds, heat and wind.
    Independent of general traffic flow.
    Easy access to other areas of OT.
    SIZE:
    General OT unit 18’ x 18’ or 40 Sqmeter.
    Super specialist OT unit 60 Sqmeter.
    Additional room for heart lung machine, c-arm etc.
    Paired OTs help in proper utilization of instruments and equipments.
  • 6. NUMBER OF OTs
    1.No. of OTs = One OT unit for 50 surgical beds.
    2. No. of operations/ day = No. of Surgical beds
    Average length of stay surgical patient
    3. No. of operations/ day = No. of Surgical beds x % of Bed occupancy x 365
    ALS x 100 x No. of working OT days
    The number of operations per suit should not exceed 06 per day or 8 to 10 hr.
    per day.
  • 7. FACTORS INFLUENCING NO. OF OTs
    TYPE OF
    HOSPITAL
    TYPE OF
    SURGERY
    NO. OF HOSPITAL
    BEDS
    HOSPITAL
    POLICY
    FACTORS
    STAFF & STRENGTH
    & CAPACITY OF
    STERILE SUPPLY
    AVERAGE NO. OF
    OPERATIONS
    TIME FOR OT
    MAINTENANCE
    TURN OVER
    RATE IN OT
    AVERAGE LENGTH
    OF STAY
    PROJECTED
    EMERGENCY
    SURGICAL CASES
  • 8. NO. OF OTs AS PER HOSPITAL BEDS
    (COMMITTEE ON PLAN PROJECT)
    In addition of this additional OT suits for CTVS, Renal & Paediatric Surgery.
  • 9. ADVANTAGE OF GROUPING OF OTs
    FLEXIBILITY IN
    USE
    EASY EXPANSION
    IN FUTURE
    BETTER TRAINING
    &
    STAFF UTILIZATION
    OT
    GROUPING
    BETTER UTILIZATION
    OF
    EQUIPMENTS &
    INSTRUMENTS
    BETTER
    MAINTENANCE
    MINIMIZE
    INFECTION
    BETTER CLEANING
    &
    ASEPSIS
    FLEXIBILITY IN
    OT ALLOCATION
  • 10. ZONING OF OTs
    Based on the bacterial consideration and to provide maximum asepsis the entire OT complex can be divided into various zones.
    CLEAN
    ZONE
    PROTECTIVE
    ZONE
    ZONNING
    DISPOSAL
    ZONE
    ASEPTIC
    ZONE
  • 11. Reception, Patient identification and Case sheet check
    Waiting area for relatives
    Changing room for OT staff and surgeons
    Pre- anesthesia room
    Store room, trolley boy
    Autoclaves
    Record and controller room
    OT in charge, Electric Control
    Seminar and meeting room
    Entrance to observation gallery
    PROTECTIVEZONE
  • 12. CLEAN ZONE
    Patient preparation Room
    Recovery Room
    Plaster Room, Blood Storage, Frozen Section
    Work Room for doctors, sisters
    Nurses Duty Room
    Anaesthesia Room
    Equipment Room, drugs, lines, X-ray board
    Clean closet, telephone and fire fighting equipments
  • 13. STERILE OR ASEPTIC ZONE
    Main Operating Suits
    Scrub Station
    Anaesthesia Station
    Instrument Sterilization and trolley lying
    DISPOSAL ZONE
    Dirty Wash up Room
    Disposal Corridor; connected to clean zone
    Janitor Closet
    SCRUB STATION
    96 cm height with water taps with sensors 10 cm high. Both hot water and
    cold water, soap liquid and scrubber.
  • 14. ENVIRONMENTAL FACTORS
    ELECTRICITY:
    Ensure round the clock electric supply
    Stand by generator system
    UPS for all equipments and gazettes
    Central field illumination 2000-3000 candles/ sqmt
    Floor around table 200-300 candles/ sqmt
    Minimum Glares, four power outlets on each wall at height of 1.5 meter
    Structured cabling system, Isolation Circuit for appliances
    Separate copper earthing, avoid extension cords
    OPERATING LIGHT:
    Shadow less, mobile, hanging pendent easily maintainable OT light.
    Intensity should be 4000 lux at incision and 8000 lux at 9 cm deep.
  • 15. AIR CONDITIONING
    • Control asepsis, controlled air flow, positive pressure.
    • 16. Maintenance of temperature 220C for comfort.
    • 17. Humidity 55 % + 5 percent.
    • 18. 100% fresh air with 20 changes per hour.
    • 19. Filter of 1 to 3 micron size to be used.
    • 20. Central air-conditioning system.
    • 21. False ceiling 1 meter below the roof.
    VENTILATION
    • There should be +ve pressure ventilation with lowering pressure gradient from sterile to protective zone. Laminar flow.
    • 22. All anaesthetic gases to be vented out to exhaust.
    • 23. Flow of air 2 to 3 cu meter/ minute.
    • 24. Air removal from floor level through weighted levers.
  • PLUMBING
    • Swearage shaft should not pass through operating room.
    • 25. Impervious lining to seal contamination.
    • 26. Toilets to be provided in change room area.
    • 27. All fire safety measures to be taken.
    • 28. Gas pipe line system to be ensured.
    WATER SUPPLY
    • Adequate and running fresh water supply to be ensured.
    • 29. Taps should be easily handled or foot operated.
    • 30. Ensure self water flow after de salination.
  • AUTOCLAVE ROOM
    Provision of steam supply.
    Proper maintenance of autoclaves.
    Linen supply should be regular and adequate.
    Theater sterilization unit.
    Attached to the theater.
    Equipments to be kept in cup boards.
    Diagnostic/ operating instruments in Lysol.
    OT ADMINISTRATION
    • Operation Theater Committee
    • 31. Each unit must have from 4-7 O.T staffs.
    Chief Surgeon
    O.T Assistant
    Chief Anaesthetist
    Anaesthesia Assistant
    Scrub Nurse
    Anaesthetic Nurse
    Circulating Nurse
    O.T Nurse for assisting
    Attendants, Safaiwala, OT technicians
  • 32. PHYSICAL ACTIVITIES
    ADMINISTRATIVE
    AREA
    SUPPORTIVE
    SERVICES
    RECEPTION OF
    PATIENT
    PHYSICAL
    FACILITIES
    HOUSE
    KEEPING
    STORE
    KEEPING
    REPAIR &
    MAINTENANCE
    CLERICAL
    ACTIVITY
  • 33. PATENT RELATING ACTIVITY
    • Reception and pre – operative preparation.
    • 34. Identification of patient and part to be operated.
    • 35. Shifting patient to OT table.
    • 36. Administration of anaesthesia, intubation positioning.
    • 37. Preparation of surgical area and draping.
    • 38. Intubation after operation, recovery from anaesthesia.
    • 39. Shifting of patient to recovery room.
    SUPPORTING ACTIVITY
    • OT Dressing
    • 40. Scrubbing and hand washing
    • 41. Gowning, putting gloves
    • 42. Checking of equipments and instruments
  • ADMINISTRATIVE ACTIVITIES
    • Preparation of operation schedule
    • 43. Preparation of OT list
    • 44. Requisition of patient
    • 45. Identification of patient, part and records
    • 46. Shifting patient to OT
    • 47. Preparation for doctors and assisting staff
    CLERICAL ACTIVITIES
    • Operation Note
    • 48. Transfusion Record
    • 49. Consent to patient for operation
    • 50. Post of operative advise
  • HOUSE KEEPING
    • Collection of soiled linens
    • 51. Counting and collection of soiled instruments, disposables
    • 52. Counting of abdominal sponges
    • 53. Cleaning of OT table and area
    • 54. Preparation to receive next patient
    STORE KEEPING
    • Ensure require medicines and instruments are ready.
    • 55. Indent and stocking of essential drugs and injections.
    • 56. Different kind of fluids and blood.
  • INTERNAL DESIGNING
    WALLS:
    • Melanin facing walls for easy cleaning
    • 57. Height should be 3-3 ½ meter.
    • 58. Pale color to be used.
    • 59. Resistant to minor damage or impact.
    • 60. Free of cravices and flaking.
    • 61. All corners to be smoothly carved.
    • 62. Door should be 1.5 meter wide, swinging and 7 feet height.
    ROOF:
    • Same as walls, but can take the load of OT lights, X-ray unit, TV camera,
    gas and electric panels.
    FLOOR:
    -Easily washable, non staining, impervious
    • Moderately electro conductive
    • 63. Vinyl conductive flooring is best
  • FIXTURES AND INSTALLATIONS
    • Minimum equipments in OT suits.
    • 64. Adequate free area around the table for free movement.
    • 65. Tables connected to Gas Pipe Lines .
    • 66. No loose over head beams or pipes.
  • hospiad
    Hospital Administration Made Easy
    THANK YOU
    http//hospiad.blogspot.com
    An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator.
    DR. N. C. DAS